Effect of gastric bypass surgery on mRNA expression level of hepatic phosphoenolpyruvate carboxykinase in type 2 diabetic Goto-Kakizaki rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of gastric bypass surgery(GBP) on hepatic phosphoenolpyruvate carboxykinase(PEPCK) mRNA expression in type 2 diabetic Goto-Kakizaki rats.</p><p><b>METHODS</b>Male GK rats were randomized into three groups: gastric bypass surgery(n=10), sham operation with diet restriction(n=10), and sham operation alone(n=10). Liver specimens of GK rats were collected during the intraoperative period for self-control study and 8 weeks after surgery. Fasting blood glucose, food intake, and body weight were recorded before surgery and 1, 2, 4, 8 weeks after surgery. The expression of PEPCK mRNA was measured by real-time PCR.</p><p><b>RESULTS</b>The fasting plasma glucose level decreased from(17.6±2.1) mmol/L before surgery to(7.5±0.9) mmol/L 8 weeks after surgery in GBP group. The level of PEPCK mRNA decreased from 1.08±0.38 before surgery to 0.41±0.10 8 weeks after surgery, significantly lower than that in sham operation alone group(1.04±0.12)(P<0.01). The level of PEPCK mRNA in diet restriction group increased from 1.15±0.16 before surgery to 2.54±0.82 8 weeks after surgery(P<0.01). The expression of PEPCK mRNA in diet restriction was significantly higher than that in CBP group(P<0.01).</p><p><b>CONCLUSIONS</b>GBP can significantly improve hyperglycemia in type 2 diabetic GK rat models, which may be associated with the decrease of hepatic PEPCK mRNA level.</p>

Impact of techniques for gastrointestinal tract reconstruction following gastrectomy on pancreatic β-cell function in patients with type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of different techniques for gastrointestinal tract reconstruction on postoperative pancreatic β-cell function in patients with type 2 diabetes mellitus (T2DM).</p><p><b>METHODS</b>Twenty-three patients with gastric cancer and T2DM were studied. Techniques for reconstruction included Billroth I (n=13) and bypass procedures(Billroth II n=4 and Roux-en-Y anastomosis n=6). Pancreatic β-cell function was evaluated by oral glucose tolerance test (OGTT). Serum insulin was measured by electrochemiluminescence immunoassay and blood glucose by glucose oxidase method. HOMA-IR and HOMA-β were assessed.</p><p><b>RESULTS</b>T2DM remission rate was 90% (9/10) in the bypass group, and 23% (3/13) in Billroth I group (P<0.01). Glycosylated hemoglobin A1c and glycated hemoglobin HbA1 were improved significantly in patients after bypass procedures(P<0.05), but the difference in Billroth I group was not statistically significant (P>0.05). OGTT showed that fasting and post-glucose load plasma glucose at each time point were significantly lower in the bypass group compared to the Billroth I group. At 30 minutes and 60 minutes after glucose load, insulin levels and insulin release index were significantly higher in the bypass group compared to Billroth I( group, as were levels of HOMA-β and ΔI30/ΔG30 in the bypass group(P<0.05).</p><p><b>CONCLUSION</b>Gastrointestinal bypass following gastrectomy may induce resolution of T2DM and improve β-cells function.</p>

Laparoscopic resection of submucosal tumors in gastric fundus / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of extraluminal laparoscopic wedge resection (ELWR) in treating submucosal tumors in the gastric fundus.</p><p><b>METHODS</b>Clinical data of 84 patients underwent ELWR for submucosal tumors in the gastric fundus between September 2000 and December 2006 were reviewed and analyzed retrospectively. The four-portal operation procedures were carried out as follows: localization of the tumor, dissection of the omentum, mobilization of the gastric fundus and the upper polar of spleen, exposure of ECJ, and resection of the gastric fundus with Endo GIA.</p><p><b>RESULTS</b>The patients included 53 males and 31 females, age ranged from 32 to 78 years (mean, 59 years). The mean tumor diameter was (4.2 +/- 1.3) cm. The distance from the tumor edge to the ECJ was 1.1 - 3.0 cm. The operations were successful in all the 84 patients, with a mean operation time of (62.6 +/- 8.9) min and mean operative blood loss of (86.2 +/- 8.1) ml. No apparent tumor focus was left. No operation was converted to open surgery, and no significant postoperative complications occurred. The mean post-operative hospital stay was (5.6 +/- 0.5) days. The gastrointestinal function recovered within 36 h after operation in 66 cases (78.6%), and the patients returned to normal activity and restored oral feeding. The distance between the tumor and the resection margin was 0.7 - 2.5 cm from the ECJ [mean, (1.4 +/- 0.5) cm], and 2.5 - 6.0 cm from the other three sides [mean, (4.1 +/- 1.0) cm]. Of the 84 cases, 29 cases were diagnosed with leiomyoma, 51 cases different types of stromal tumor and 4 cases neurofibroma. The mean follow-up duration was (51.0 +/- 4.3) months, no recurrence or metastasis was found in the mean time.</p><p><b>CONCLUSIONS</b>ELWR is a safe, simple and beneficial procedure for submucosal tumors in the gastric fundus, especially in the posterior wall near the ECJ. It avoids intraperitoneal infection, possible splenic injury and postoperative esophageal stenosis. In addition, the resection scope is not limited.</p>

Application of laparoscopic compression anastomosis clip for laparoscopic gastrointestinal anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of laparoscopic compression anastomosis clip (LapCAC) for laparoscopic gastrointestinal anastomosis.</p><p><b>METHODS</b>In March, 2007, three gastric cancer patients undergone total gastrectomy (1 case) and distal gastrectomy (2 cases) received laparoscopic gastrointestinal anastomosis with LapCAC. The gastrointestinal anastomotic complications, first post-operational flatus, bowel movement and extrusion of clip device were observed.</p><p><b>RESULTS</b>No anastomotic complications such as leakage or obstruction were found. The clip was expelled with stool within 12-18 days. All the patients had good results in recovery of bowel function.</p><p><b>CONCLUSION</b>LapCAC is safe and simple for laparoscopic gastrointestinal anastomosis.</p>

Efficacy of sleeve gastrectomy plus gastric remnant banding on weight reduction and remnant gastric dilatation: an animal experimental study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of sleeve gastrectomy plus gastric remnant banding on weight reduction and remnant gastric dilatation in SD rat model.</p><p><b>METHODS</b>Sleeve gastrectomy plus gastric remnant banding was performed in 20 male SD rats as the study group; sleeve gastrectomy was performed in 20 SD male rats as the control group, and laparotomy was performed in 10 SD male rats as the blank control group. Body weight was measured before the experiment, at day 1 and at 2-week intervals within 16 weeks after operation.</p><p><b>RESULTS</b>The number of survival rats was 15 in the study group (15/20), 13 in the control group (13/20), and 10 in the blank control group (10/10). Postoperative body weight increased markedly in the blank control group, returned to the pre-operative level two weeks after operation in the control group, and four weeks after operation in the study group. Weight increase of the study group was significantly slower than that of the other two groups (P<0.01). Postoperative gastric dilation of the control group was more obvious as compared to the study group.</p><p><b>CONCLUSION</b>Sleeve gastrectomy plus gastric remnant banding is safe and effective because of the restriction of postoperative gastric dilation.</p>

Effect of immune-enhanced enteral diet on postoperative immunological function in patients with colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the influence of immune-enhanced enteral diet on postoperative metabolism and immunological function in colorectal tumor patient.</p><p><b>METHODS</b>Seventy-two patients with colorectal cancer were enrolled in this study. Immune-enhanced enteral diet was administrated in 36 cases (study group), while regular enteral nutrition (EN) was given in 36 cases (control group). The immunological function, inflammatory function and nutrition index were evaluated before operation and on postoperative day 1 and day 8.</p><p><b>RESULTS</b>Serum levels of glutamine, asparagines, CD4 (+), NK, IgG, IgM were higher in the study group than those in the control group. The levels of IL- 6, TNF-alpha in the study group were lower than those in the control group. The difference was statistically significant (P< 0.05).</p><p><b>CONCLUSIONS</b>Immune-enhanced enteral diet can ameliorate the cell immunological and fluid immunological function in the patients with colorectal cancer after the procedures.</p>